A 36-Year-Old Man Comes to the Physician for a Routine

A 36-year-old man comes to the physician for a routine visit.  He has no complaints except for gradual weight gain over the past few years.  He is an administrative assistant in a law firm and spends most of his time working at his desk.  He eats mainly fast food for lunch and drinks a few beers while watching television on weekends.  The patient does not use tobacco or recreational drugs.  He has no family history of coronary heart disease, hypertension, or diabetes mellitus.  His father died at age 47 in a ski accident.  His mother is 66 years old and has no medical problems.
The patient's blood pressure is 124/70 mm Hg, pulse is 70/min, and body mass index is 30 kg/m².  He has no other notable physical findings such as acanthosis, skin or tendon xanthomas, or thyromegaly.  Examination of his fundi is normal.
Fasting laboratory results are as follows:
His serum creatinine, liver function tests, and thyroid-stimulating hormone are normal.  His calculated 10-year risk of cardiovascular disease is approximately 1%.
In addition to lifestyle modification, which of the following is the most appropriate next step in management of this patient?

A) Atorvastatin
B) Fenofibrate
C) Low-dose aspirin
D) Nicotinic acid
E) No medication at this time

Correct Answer:

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